Closed loop obstruction and adhesive intestinal obstruction in perineal hernia

Area of Science:

• Colorectal Surgery
• Surgical Complications
• Hernia Repair

Background:

• Laparoscopic extralevator abdominoperineal excision (ELAPE) is increasingly performed for rectal cancer.
• Perineal hernias are an uncommon but recognized complication following ELAPE, potentially leading to severe outcomes.
• Pelvic floor reconstruction is often not performed during ELAPE, increasing the risk of hernia formation.

Observation:

• A patient developed a small bowel obstruction with gangrene 7 years after ELAPE.
• The obstruction was caused by an incarcerated perineal hernia, a rare late complication.
• Intraoperative findings revealed adhesions and a closed-loop obstruction of the distal small bowel.

Findings:

• Successful surgical management involved adhesiolysis and repair of the perineal defect with a biological mesh.
• The patient's condition was resolved through prompt surgical intervention.
• This case underscores the potential for delayed complications after ELAPE.

Implications:

• The incidence of perineal hernias post-ELAPE is expected to increase.
• Enhanced patient surveillance and reporting of such cases are crucial for raising awareness.
• Educating patients about the signs and symptoms of perineal hernias after ELAPE is vital for timely medical attention.